Heart Conditions

The Basics

In discussing the basics of heart conditions and blood pressure we’ll start with some “how things happen” essentials and some emergency facts we should all have. This will lead us into dealing with both acute and chronic conditions.

We’ll look at what they are, how they’re treated, the importance of blood pressure and other factors, and how you can improve your own condition and quality of life. If the basics and emergency facts are old news to you and you’re more interested in therapies and condition management, go straight to those sections.

The heart has three basic systems, much like the systems in a car engine.

• The Fuel Line is the blood flow
• The Electrical System is made up of special heart muscle cells carrying electrical impulses through the heart.
• The mechanical system is primarily the heart muscle contracting to pump blood, and valves which open and close to keep blood flowing in the right direction.

If any one of these systems is damaged it can cause serious problems and affect the other systems.The most common origins of heart problems involve the flow of blood. The blood in our bodies flows through a system of arteries and veins. Arteries carry blood away from the heart to the rest of the body. Veins return blood to the heart. The heart is the pump, driving the blood through the system.

Cardiovascular Disease is the general name for diseases affecting the heart and the arteries supplying blood to the rest of the body.

Arteries carry blood filled with oxygen to all the tissues of the body. When every part of our body has taken the oxygen it needs to function, the veins return the blood to the heart. This returning blood needs to be filled with oxygen again, so the heart pumps it to the lungs where it’s loaded with fresh oxygen. The heart than takes this oxygenated blood back and pumps it back out to deliver more oxygen to the body.

The basic pattern then, is from the heart through the body, back to the heart to be sent to the lungs for fresh oxygen, and back out through the body again. It’s a nice simple pattern, but it only works if the heart pump is able to keep it flowing and the blood keeps flowing in the right direction. The heart muscle has to function well to pump, and a series of valves need to work properly and not leak so blood doesn’t seep backwards or leak out of the system.

Coronary Artery Disease

In modern societies the most common of these conditions is Atherosclerosis, or “hardening of the arteries”. This begins almost from birth. Atherosclerosis is a complex process started by injury to the lining of the arteries. Some forms of cholesterol, “free radicals” and many other things mounting up in our systems as we live are thought to play a part. Our bodies respond by sending white blood cells to fight off whatever is damaging us, but this activity creates scarring. Gradually over time the white blood cells, scar tissue and cholesterol form a plaque, narrowing the space for blood to flow through the artery. A lime scale deposit furring up and starting to block the pipes in your home’s plumbing is a good image of what’s going on here.

The major risk factors for coronary artery disease are:

• High blood pressure
• Smoking
• High cholesterol
• Diabetes
• Family history

Stenosis is the medical term for the narrowing of the arteries. The result as the condition advances is that the heart muscle (myocardium) doesn’t get enough blood to work properly. This lack of blood is called myocardial ischaemia. It can cause chest pain (angina). Angina may come with shortness of breath, and sometimes nausea, sweating or fainting. These are heart attacksymptoms.

A heart attack (or Myocardial infarction) usually happens when a blood clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat – called an Arrhythmia – that causes a severe decrease in the pumping function of the heart. A blockage that is not treated in time causes the affected heart muscle to die.

Heart attack symptoms: a heart attack is a critical emergency. minutes count. Suspect a heart attack, and Dial 999 without hesitation, if you or someone you’re with has any combination of:

• Discomfort in the centre of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness/pressure or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• A cold sweat, nausea or light-headedness (this could be simple fainting, but take no chances)
• Ashen skin and blueness in lips
• Rapid then weakening pulse

Heart attack first aid:

• If the person is conscious and able to swallow, give one aspirin (ideally to be chewed slowly). Do not give fluids.
• If the person has tablets or an aerosol for angina, help to get to and use them
• The heart attack victim can try taking deep breaths and cough as long and hard as possible between breaths.

Deep breaths get oxygen into the lungs and really hard coughing squeezes the heart and keeps the blood circulating. The squeezing pressure can help the heart regain its normal rhythm. RSVP posts this advice in GP surgeries. They advise that this coughing technique can be lifesaving while waiting to get help.

If the person becomes unconscious, has no pulse/stops breathing, begin CPR immediately. If a defibrillator is available and you know how
to use it, do so. If you don’t know how to do these things please consider taking a basic life saving course (see our First Aid section).

Angina

Angina is chest pain or discomfort you get when your heart muscle does not get enough blood. It may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. When you exert yourself the heart needs more fuel. If the artery flow is restricted the heart may struggle, producing exertional angina. Angina in itself does not necessarily mean you are having a heart attack, but it does mean there is a serious blood supply problem.

The chest pain of Angina may often also radiate into the arms, back, neck shoulders or jaw. There are other conditions which may cause these symptoms, but if you or someone you’re with has radiating pain with chest pain, CALL 999.

There are two basic types of angina: People who have had angina for a while may have stable angina. They know pretty much what level of exertion they can take, and how to rest and let it subside. Unstable angina is angina with where the pattern changes: more or different pain, pain lasting longer or coming on with less exertion, or an unexpected angina. Unstable angina is a medical emergency and may be a heart attack. Call 999.

Quite a high number of people can have what we might call “Silent Angina”: the heart isn’t getting enough blood flow but there is no chest pain. There may be other symptoms, or nothing very dramatic at all. This means that you could well have a heart attack and resulting damage without knowing it.

A heart attack is heart muscle dying from lack of blood flow. This occurs most often when some plaque build-up in a coronary artery breaks, exposing substances which promote clot formation in the blood. The resulting blood clot, or thrombosis, stops blood from feeding the heart itself. The heart muscle, starved of blood, begins to die. This causes chest pain like severe Angina, but usually lasts longer and may be more severe. For the avoidance of doubt, let’s repeat: if you suspect a heart attack you are dealing with an extreme medical emergency, and minutes count. To minimise damage and increase chances of survival the blood flow to the heart must be re-established as quickly as possible. DO NOT HESITATE if you suspect a heart attack. Call 999. Use the first aid techniques above while waiting, if possible.

Sudden Cardiac Death

Sudden death from cardiac arrest is a major health problem that has received much less publicity than heart attack. Sudden cardiac death occurs on average at about 60 years of age, claims many people during their most productive years, and devastates unprepared families.

Sudden cardiac death happens when the heart stops abruptly (cardiac arrest). The victim may or may not have diagnosed heart disease. Death can occur within minutes after symptoms appear, or there may be no symptoms before collapse. The most common underlying reason that patients die suddenly from cardiac arrest is coronary heart disease.

In 90 percent of adult victims of sudden death, two or more major coronary arteries are narrowed by atherosclerosis. Scarring from a prior heart attack is found in two-thirds of victims. Adrenaline released during intense athletic or physical activity often triggers sudden death when these abnormalities are present. Under certain conditions, various heart medications and other drugs — as well as illegal drug abuse — can lead to abnormal heart rhythms that cause sudden death.

Most known heart diseases can lead to cardiac arrest and sudden death. Most of the cardiac arrests that lead to sudden death occur when the electrical impulses in the heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm causes the heart to suddenly stop beating. A small number of cardiac arrests are caused by extreme slowing of the heart (bradycardia).

During cardiac arrest, a victim collapses suddenly, becomes unresponsive, stops normal breathing, and loses pulse or other signs of circulation. If this happens begin cardiopulmonary resuscitation (CPR) immediately. This will help keep the cardiac arrest victim alive until emergency help arrives. CPR keeps blood flowing to the heart and brain until defibrillation can be provided.

Brain death and permanent death start to occur in just 4 to 6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversed in most victims if it’s treated with immediate CPR and an electric shock to the heart within 7 to 10 minutes. Again, if you don’t know basic cardio-pulmonary resuscitation (CPR), do consider taking a short course. Immediate CPR and rapid defibrillation combined with early advanced care can produce high long-term survival rates for cardiac arrest. Needless to say, whatever else you do, call 999.

Atrial Fibrillation

Atrial fibrillation causes a very irregular and, usually, rapid heart rate due to disorganized electrical activity in the upper heart chambers which are called the right and left atrium or atria. Electricity usually flows smoothly in the heart muscle but becomes irregular and disorganized in the atria during episodes of atrial fibrillation (AF). AF can occur in short episodes called paroxysmal AF or longer episodes called persistent AF. When AF is present for very long periods of months or years it is called permanent AF. To visualize what AF looks like, imagine a very still swimming pool with a smooth surface. If a pebble is dropped into the water a series of waves will spread out from the entry point of the pebble in smooth circles. When a normal electrical impulse forms in the right atrium, coming from the pacemaker cells, this impulse spreads through the heart in a smooth fashion. Now, imagine the swimming pool in a rain storm with waves everywhere. That is what the electrical activity in the atria looks like during atrial fibrillation. Atrial fibrillation is very common and becomes more common as we age. Up to 10% of people over the age of 70 may have AF.

Atrial Fibrillation increases the risk of stroke. Because blood doesn’t flow as smoothly in the atria during AF small clots may form along the atrial walls and these can fall off and be carried to the brain where they obstruct blood flow and cause a stroke. This risk also increases with age and if other risk factors for stroke are present such as diabetes or high blood pressure.

AF can cause a number of symptoms. The type of symptoms will depend on several factors including whether other types of heart problems are present. AF may cause congestive heart failure, chest pain, shortness of breath or fainting. The most common symptom is a sensation of rapid irregular heart beat or “palpitations”. In the presence of abnormal heart valves or reduced heart function, these symptoms may be more severe.

Looking at the About website (a good site for most subjects) we learn that: The cardiac electrical system regulates the frequency of the heart beat (i.e. it sets the heart rate), and it coordinates the contraction of the heart muscle, so that the heart beats efficiently.

Cardiac Arrhythmias are abnormal heart rhythms from problems in the heart’s electrical system. Abnormally slow arrhythmias are called the bradycardias, and abnormally rapid arrhythmias are called tachycardias.

A pacemaker is a sophisticated electronic device to deal with many arrhythmias. It does two things: 1) It analyses the function of the heart’s own electrical system. 2) When necessary, it sends tiny, precisely-timed electrical signals to the heart, to correct certain abnormalities in the heart’s electrical system. Most pacemakers are designed to correct the bradycardias (the slow arrhythmias.) Abnormally slow heart rhythms can cause weakness, fatigue, light-headedness, dizziness, loss of consciousness, or even death. Pacemakers, properly used, effectively eliminate all of these symptoms.

Heart Failure

BBC Sources suggest that Heart failure is responsible for one in 20 admissions to hospital and is more deadly than many cancers. The good news for sufferers, however, is that it can be treated.

We’ve described the heart as a muscular pump providing blood flow to the rest of the body. As with any piece of machinery, as it gets older or if it’s damaged in any way, it won’t work efficiently. When this happens, people notice they haven’t as much energy as before, that they get tired more easily and out of breath more quickly. They may also notice their ankles swelling.

The most common symptoms of heart failure are severe breathlessness, tiredness and swelling of the ankles and feet. Because the symptoms of heart failure are common to other medical problems, certain tests are needed to confirm the diagnosis. These may include a chest x-ray to show whether the heart is enlarged, an electrocardiogram to detect any abnormal heart function and, probably most importantly, an echocardiogram. This is a special type of ultrasound that shows how well the heart and its valves are working. In addition, blood tests will be performed and blood pressure must be measured.

These symptoms tend to develop gradually and usually go unnoticed for a long time. With heart failure the heart doesn’t fail totally and stop; it struggles and is inefficient, and causes fluid to collect in the lungs and legs.

Common causes of heart failure include:

• Angina
• Heart attack
• High blood pressure
• Heart valve damage (allowing blood to leak and to flow the wrong way)
• Excessive alcohol
• Inherited heart conditions, such as Cardiomyopathy (a group of diseases enlarging the heart or make it thicker and more rigid than normal).
• Some viruses and other infections (including dental abscess) can also affect the heart and cause damage quickly

The most common cause of heart failure is another heart problem such as angina or a previous heart attack. A third of cases are caused by high blood pressure, which causes the heart’s muscular wall to thicken, making it less flexible and unable to pump blood properly.

Diagnosis of heart failure begins with your doctor examining you and listening to you about your symptoms, doing an ECG (electrocardiogram) and arranging blood tests. You may than need an Echocardiogram. This procedure is similar to an ultrasound scan. No pain or discomfort involved and it shows an accurate picture of heart structure, valves and pumping action. It’s also a tool for looking specifically at heart valve disease.

Heart Valve Disease

Heart valve disease usually develops over time, affecting people aged 60 or over, but it can be the result of an infection which damages the valve in a matter of days. The condition is often present at birth (congenital heart disease), the child being born with valves made of two parts rather than theusual three. Gradually the valve wears and becomes thicker to the point where it has to be replaced. Rheumatic fever used to be a common cause; the effect of bacteria is to damage the valve, preventing it opening or closing properly. Acute infection (endocarditis), sometimes as a result of an abscess of a tooth, is however still a common cause of valve disease. Bacteria can destroy the valve in as little as a week. If one or more of the four heart valves are diseased or damaged it can affect the flow of blood in two ways.

If the valve does not open fully, it obstructs the flow of blood – known as valve stenosis. If the valve does not close properly, it will allow blood to leak backwards – called valve incompetence or valve regurgitation. Both put extra strain on the heart. Symptoms include tiredness or breathlessness when exercising, swelling of the ankles and legs, dizziness or fainting in extreme cases. Angina can occur. Treatment with drugs can be used to control the problem, or in severe cases, surgery to replace a heart valve may be necessary.

High Cholesterol Level (hypercholesterolaemia)

Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic abnormality that can be secondary to many diseases and can contribute to many forms of disease. It can play a very big role in cardiovascular disease.

A high level of cholesterol is one of the factors that can increase your risk of cardiovascular disease, angina, heart disease and stroke. High levels of cholesterol lead to fatty deposits that cause the arteries to narrow (atherosclerosis) and restrict blood flow to the heart, causing cardiovascular disease.

Everyone should have their cholesterol level measured at least once before they are far past middle age. Cholesterol levels don’t tend to fluctuate, so if you have a normal level it doesn’t need to be repeated for many years.

Have you’re your doctor check your cholesterol level if it hasn’t been done recently, and consultHeart UK for any and all the help you need.

High Blood Pressure (hypertension)

Based on information from Netdoctor every adult over 40 should have their blood pressure checked. Being a pump, our hearts push blood under pressure around our bodies.  Too much blood pressure puts a strain on the arteries and on the heart itself. This can cause an artery to rupture or the heart to fail under the strain – in the worst case stopping altogether. Hypertension occurs when blood is forced through the arteries at an increased pressure. Blood pressure depends on a combination of two factors:

• how forcefully the heart pumps blood around the body
• how narrowed or relaxed your arteries are.

High blood pressure is extremely common and can lead to so many problems. Easy to diagnose and help is at hand. It’s so important to know how yours is. Blood pressure is measured using two numbers. An example of this could be ‘120 over 80’, which is written as ‘120/80mmHg’. The first number is the systolic blood pressure – the maximum pressure in the arteries when the heart contracts (beats) and pumps blood out into the body.

The second figure is the diastolic blood pressure. This is the minimum pressure in the arteries between beats when the heart relaxes to fill with blood. Because the height of a mercury column is used in blood pressure gauges, standard blood pressure readings are always written as so many ‘millimetres of mercury’, which is abbreviated to ‘mmHg’. The systolic pressure is always listed first, then the diastolic pressure. A typical normal blood pressure reading would be 120/80 mmHg.

Determining high blood pressure

There is a natural tendency for blood pressure to rise with age due to the reduced elasticity of the arterial system. Age is therefore one of the factors that needs to be taken into account in deciding whether a person’s blood pressure is too high. In general terms, people with a systolic blood pressure consistently above 160mmHg and/or a diastolic pressure over 100mmHg need treatment to lower their blood pressure.

People with slightly lower blood pressures (140-159mmHg systolic or 90-99mmHg diastolic) may also need treatment if they have a high risk of developing cardiovascular disease, eg stroke or angina (chest pains). Symptoms may be invisible. One of the big problems with high blood pressure is that by itself it hardly ever causes symptoms. This means it may go unnoticed until it causes one of its later complications such as a stroke or heart attack. Severe hypertension can cause symptoms, including headache, sleepiness, confusion, and even coma.

Complications caused by high blood pressure can come with dramatic symptoms. Complications can include:

• Atherosclerosis: narrowing of the arteries
• Stroke: haemorrhage or blood clot in the brain
• Aneurysm: dangerous expansion of the main artery either in the chest or the abdomen, which becomes weakened and may rupture
• Heart attack
• Heart failure: reduced pumping ability
• Kidney failure
• Eye damage

In other words, if you have high blood pressure (hypertension), deal with it. With your doctor’s help and your own lifestyle changes you can.

The cause of hypertension is hard to determine in most people. For more than 90 per cent of those with high blood pressure the cause is unknown. This is called ‘primary’ or ‘essential hypertension’. In the remaining 10 per cent or so, there is an underlying cause. This is called ‘secondary hypertension’.

Some of the main causes for secondary hypertension are chronic kidney diseases, diseases in the arteries supplying the kidneys, chronic alcohol abuse, hormonal disturbances and endocrine tumours.

If you have high blood pressure it is far more likely to be primary hypertension. Anyone can suffer from high blood pressure, but certain factors can seriously aggravate hypertension and increase the risk of complications:
a tendency in the family to suffer hypertension

• obesity
• smoking
• diabetes Type 1 or Type 2
• kidney diseases
• high alcohol intake
• excessive salt intake
• lack of exercise
• certain medicines, such as steroids

Everyone over 50 should know their blood pressure and cholesterol levels. It makes all the difference to start treatment and lifestyle changes before any complications arise.